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Roux-en-Y gastric bypass (RYGB) was associated with an increased risk of alcohol use disorder (AUD)-related hospitalizations compared with sleeve gastrectomy and a weight management program, a Veterans Affairs cohort study indicated.

After adjusting for body mass index and time-updating alcohol use, RYGB was linked to an increased hazard of AUD-related hospitalizations compared with sleeve gastrectomy (HR 1.98, 95% CI 1.55-2.53, P<0.001) and the MOVE! program (HR 1.70, 95% CI 1.20-2.41, P=0.003), reported Nadim Mahmud, MD, MPH, of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues.

There was no significant difference between sleeve gastrectomy and the nonsurgical intervention (HR 0.76, 95% CI 0.56-1.03, P=0.08), they noted in .

"These findings highlight the importance of careful patient selection for RYGB, strict counseling regarding alcohol use, and long-term monitoring for AUD-related complications," Mahmud and team concluded.

Although RYGB was associated with a reduction in all-cause mortality risk versus those in the MOVE! program (HR 0.63, 95% CI 0.49-0.81, P<0.001), this link ultimately disappeared due to increasing alcohol use over time.

However, the increased risk of AUD-related hospitalization may not completely be explained by the patients simply drinking more and may have more to do with the specifics of the RYGB procedure, Mahmud's group explained.

"We found that patients who underwent RYGB had a higher risk of AUD-related hospitalization despite generally consuming the least amount of alcohol at baseline or during follow-up," they wrote, "suggesting that alterations in alcohol metabolism, more than changes in alcohol consumption, may be associated with increased risks of alcohol-related complications in patients who underwent RYGB."

They further explained that RYGB may reduce initial luminal metabolism, which is initiated by gastric mucosa in the proximal gut, through a reduction of gastric surface area, thus causing contents to rapidly be pushed into the small bowel. Because of this, RYGB patients may be more prone to toxic levels of blood alcohol, even if they only consume a small amount of alcohol.

This may also explain why sleeve gastrectomy patients didn't see this association, too, due to the less invasive nature of that procedure, they added.

Nonetheless, in an , Jon C. Gould, MD, MBA, of the Medical College of Wisconsin in Milwaukee, noted that this study "adds to a growing body of evidence that alcohol use can be problematic for bariatric surgery patients."

"The fact that alcohol use disorder-related hospitalizations increased over time is concerning," he wrote. "Across the country, these alcohol use disorder-related hospitalizations and other disorders are occurring at a time when patients are less likely to be actively engaged with their bariatric surgery program."

One way this could be ameliorated is by insurers making long-term bariatric care programs more accessible, Gould suggested, adding that "bariatric centers should invest in the resources to provide these services, a difficult task in an era where lack of coverage and inappropriately low reimbursement rates lead to negative financial margin for long-term care."

This study included a total of 1,854 RYGB patients (median age 53, 69.8% men), 4,211 sleeve gastrectomy patients (median age 52, 66.9% men), and 1,364 patients who were referred to the MOVE! weight management program (median age 59, 86.1% men) recruited from 127 Veterans Health Administration centers in the U.S. from January 2008 through December 2021.

A total of 265 gastric banding patients were also initially recruited, but were then excluded from the analysis due to their low sample size.

These numbers are reflective of the trends in bariatric surgery, with sleeve gastrectomy taking off as the most popular procedure beginning in 2010.

Not surprisingly, RYGB patients lost the most weight -- 29% of baseline weight -- while sleeve gastrectomy patients lost 21.6% of baseline weight. Gastric banding patients lost 12.8%, and MOVE! program participants only lost 0.7% of baseline weight.

During the follow-up period, the highest rate of mortality occurred in MOVE! participants, while the lowest rate occurred in sleeve gastrectomy patients.

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